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How to choose the right electronic health record (EHR) consultant

Kevin

Health Technology

November 19, 2009

Originally published in HCPLive.com

by Jonathan Bertman, MD

You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the …

Why health reformers should be worried about the breast cancer screening backlash

Kevin

Conditions and Diseases

November 19, 2009

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?

That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.

Here are their reasons explaining why:

The harms resulting from screening for breast cancer include psychological harms, …

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Why health reformers should be worried about the breast cancer screening backlash

Senate health reform plan analysis

Kevin

Health Policy

November 19, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon.

The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a …

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Senate health reform plan analysis

How a personal injury lawyer views the medical malpractice system

Eric Turkewitz

Physician

November 18, 2009

Personal injury lawyer Eric Turkewitz responds to my recent USA Today piece on fixing the medical malpractice system.

In a USA Today op-ed, Kevin Pho tackles the medical malpractice liability system. Some stuff I agree with, but suggestions regarding improvement of the current system are unlikely to work.

Kevin correctly states that malpractice legal fights often go on for years. In New York, it could easily take three years to get …

Can family doctors do safe first trimester abortions?

Kevin

Conditions and Diseases

November 18, 2009

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Complications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found.

Among more than 2,500 abortions performed by family physicians, abortion was successful without complications in 96.5% of patients using medications (95% CI 95.5% …

Why doctors are doing so many unnecessary Pap smears

Matthew Mintz, MD

Conditions and Diseases

November 17, 2009

The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don’t know the guidelines of how often women should get a pap smear. More importantly, doctors were doing a lot of pap smears on women who didn’t need them. In all the talk about health care reform, reducing costs by eliminating unnecessary testing has been mentioned multiple …

Learn how to conduct a family meeting by using a structured approach

Alex Smith, MD

Patient

November 16, 2009

On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.

I asked why.

A brave intern responded that he was completely at a …

Why you should stop taking Vytorin for high cholesterol

Matthew Mintz, MD

Medications

November 16, 2009

At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.

The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at …

Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

Kevin

Medications

November 16, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported.

Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean …

Who’s dying from the H1N1 flu pandemic?

Kevin

Conditions and Diseases

November 15, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Although the pandemic H1N1 flu tends to strike younger people, it can be life-threatening when older people are infected, California researchers said.

In the first four months of the pandemic, 1,088 people in the state needed inpatient care or died of the pandemic flu strain, according to Janice Louie, …

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Who’s dying from the H1N1 flu pandemic?

Saying no to a re-tweet request, and whether Twitter as a legitimate news source

Marya Zilberberg, MD, MPH

Social Media in Medicine

November 15, 2009

The other day I re-tweeted a tweet from someone whose Twitter activity I enjoy very much. I like where his links take me, and I appreciate the intellectual and emotional honesty of his own writing. The message I re-tweeted was about Gardasil, Merck’s HPV vaccine marketed in the US.

Diane Harper of the University of Missouri is a prominent researcher who was heavily involved in the Gardasil development program. Over the …

Medicine needs to get back to hands-on basics, rather than focusing on technology

Rahul K. Parikh, MD

Conditions and Diseases

November 14, 2009

There is plenty to criticize in our bungling trek toward health reform. Leaders on the right, left and at 1600 Pennsylvania Avenue have sidestepped the crucial conversation of controlling the cost of care, in favor of partisan rhetoric about “death panels” and “rationing care.” Worse, the entire focus of reform has centered on spending billions of dollars on technology solutions that will only make marginal changes in the cost and …

AMA’s democracy in action at this defining moment in the history of medicine

Kevin

Health Policy

November 13, 2009

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, M.D.

Delegates Vote to Continue AMA’s Commitment to Reform, Medicare Vote Pending in U.S. House of Representatives

Twice a year, physicians come together for an exhibit of democracy at its best through the AMA House …

Surgeons don’t receive enough training when resident work-hours are capped

Crystal Phend

Medical Education

November 13, 2009

by Crystal Phend, MedPage Today Senior Staff Writer

Limiting surgical residents’ work hours has compromised both surgical education and patient safety, according to an analysis concluding that an 80-hour work week isn’t enough.

The maximum 80-work week imposed in the U.S. for residents is too little to provide mastery in surgery, Gretchen Purcell Jackson, MD, PhD, and John L. Tarpley, MD, …

How teamwork is essential in the emergency department

Edwin Leap, MD

Physician

November 12, 2009

I recently cared for a patient who raised my heart-rate a bit. Of course, any emergency physician will tell you, the potentially difficult and complicated cases often come at the end of the shift, as you’re trying to clean up all of the paperwork and ‘head for the house.’ Nurse Ginger came to me and said, ‘we need a doctor in room 11.’ I snarled, snatched the paper, grumped and …

Many women report nerve-related persistent pain after breast surgery

Kevin

Conditions and Diseases

November 12, 2009

Originally published in Insidermedicine

Nearly half of women who undergo surgery and other treatments for breast cancer report having persistent pain in and around the treatment area a year or more later, probably because of nerve damage, according to research published in the November 10 issue of the Journal of the American Medical Association.

Here is some information about neuropathic, or nerve, pain:

• It is a type of pain that occurs when …

Will video cameras in the OR decrease the rate of wrong-site surgery?

Kristina Fiore

Conditions and Diseases

November 12, 2009

by Kristina Fiore, MedPage Today Staff Writer

Rhode Island Hospital, located in Providence, will pay $150,000 and install video cameras in all of its operating rooms after performing its fifth wrong-site surgery since 2007, according to the state’s Department of Health.

The hospital will also have to open its ORs to an inspector who will observe surgical procedures and protocols for at …

Patients who want the H1N1 vaccine need to be triaged

Kevin

Medications

November 11, 2009

by Kairol Rosenthal

I am a young adult cancer patient who waited five and a half hours for the H1N1 vaccination along with 1200 other Chicagoans in a city college hallway. I do not have the trained eye of a public health analyst, yet it was easy to spy the glaring flaws that occurred in the whimsical distribution of this short supply vaccine. One of these oversights was the absence …

How do people with dementia die?

Kevin

Conditions and Diseases

November 11, 2009

Originally published in HCPLive.com

by Victor G. Dostrow, MD

Dementia is a terminal illness. However, people with advanced dementias often languish in skilled nursing facilities, far from the ministrations of specialists. And, with reasonable luck, they have directives that specify that they are not to be taken to the hospital in the event of a respiratory arrest. Consequently, most of us are not privy to the mechanisms of demise in such situations.

Will the abortion restriction survive the Senate health reform bill?

Kevin

Health Policy

November 11, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After a controversial amendment to restrict abortion was approved as part of the House healthcare bill over the weekend, senators are grappling with the abortion language in their legislation.

Senate Majority Leader Harry Reid (D-Nev.), who personally opposes abortion, said the issue was being negotiated.

“I expect the bill that …